The Treatment of Metastatic, Hormone-Sensitive Prostatic Carcinoma.
Journal
Deutsches Arzteblatt international
ISSN: 1866-0452
Titre abrégé: Dtsch Arztebl Int
Pays: Germany
ID NLM: 101475967
Informations de publication
Date de publication:
16 09 2022
16 09 2022
Historique:
received:
08
04
2022
revised:
08
04
2022
accepted:
26
06
2022
pubmed:
2
8
2022
medline:
15
12
2022
entrez:
1
8
2022
Statut:
ppublish
Résumé
For many years, the standard treatment of metastatic, hormone-sensitive prostatic carcinoma (mHSPC) was androgen deprivation therapy (ADT) alone. By lowering the testosterone level into the castration range, ADT deprives the tumor of a key growth factor. For this article, we evaluated the treatment recommendations contained in national and international guidelines (German S3 guidelines and those of the European Society for Medical Oncology [ESMO], European Association of Urology [EAU], and National Comprehensive Cancer Network [NCCN]), as well as pertinent publications revealed by a PubMed search and the congress abstracts of the ESMO and of the American Society of Clinical Oncology [ASCO]. The past few years have witnessed fundamental changes in the treatment of mHSPC. Treatment intensification with docetaxel or with the new drugs directed against the androgen receptor signal pathway (abiraterone, apalutamide and enzalutamide) has been found to lower mortality by 19-40% and is now an integral component of first-line therapy. Relevant new findings have also been obtained with threefold combinations of ADT, docetaxel, and abiraterone or darolutamide. For patients with a light tumor burden, local radiotherapy of the primary tumor improves the probability of survival at 3 years by 8% (45.4 versus 49.1 months, difference 3.6 months; 95% confidence interval, 1.0 to 6.2 months). The treatment of mHSPC is constantly changing. Phase III trials that are now in the recruitment stage, as well as our continually improving understanding of the underlying molecular-pathological mechanisms, will be altering the treatment landscape still further in the years to come.
Sections du résumé
BACKGROUND
For many years, the standard treatment of metastatic, hormone-sensitive prostatic carcinoma (mHSPC) was androgen deprivation therapy (ADT) alone. By lowering the testosterone level into the castration range, ADT deprives the tumor of a key growth factor.
METHODS
For this article, we evaluated the treatment recommendations contained in national and international guidelines (German S3 guidelines and those of the European Society for Medical Oncology [ESMO], European Association of Urology [EAU], and National Comprehensive Cancer Network [NCCN]), as well as pertinent publications revealed by a PubMed search and the congress abstracts of the ESMO and of the American Society of Clinical Oncology [ASCO].
RESULTS
The past few years have witnessed fundamental changes in the treatment of mHSPC. Treatment intensification with docetaxel or with the new drugs directed against the androgen receptor signal pathway (abiraterone, apalutamide and enzalutamide) has been found to lower mortality by 19-40% and is now an integral component of first-line therapy. Relevant new findings have also been obtained with threefold combinations of ADT, docetaxel, and abiraterone or darolutamide. For patients with a light tumor burden, local radiotherapy of the primary tumor improves the probability of survival at 3 years by 8% (45.4 versus 49.1 months, difference 3.6 months; 95% confidence interval, 1.0 to 6.2 months).
CONCLUSION
The treatment of mHSPC is constantly changing. Phase III trials that are now in the recruitment stage, as well as our continually improving understanding of the underlying molecular-pathological mechanisms, will be altering the treatment landscape still further in the years to come.
Identifiants
pubmed: 35912436
pii: arztebl.m2022.0294
doi: 10.3238/arztebl.m2022.0294
pmc: PMC9756320
doi:
pii:
Substances chimiques
Androgen Antagonists
0
Docetaxel
15H5577CQD
Hormones
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
622-632Références
J Clin Oncol. 2022 May 20;40(15):1616-1622
pubmed: 35420921
Urology. 2021 Sep;155:165-171
pubmed: 33373705
Proc Natl Acad Sci U S A. 2019 Jun 4;116(23):11428-11436
pubmed: 31061129
Int J Urol. 2012 Jul;19(7):594-601
pubmed: 22416801
Lancet Oncol. 2019 May;20(5):686-700
pubmed: 30987939
N Engl J Med. 2022 Mar 24;386(12):1132-1142
pubmed: 35179323
Lancet. 2016 Mar 19;387(10024):1163-77
pubmed: 26719232
J Clin Oncol. 2022 Mar 10;40(8):837-846
pubmed: 34928708
Urologe A. 2021 Nov;60(11):1450-1457
pubmed: 34213627
J Clin Oncol. 2018 Feb 10;36(5):446-453
pubmed: 29240541
Cancer Discov. 2017 Jul;7(7):736-749
pubmed: 28411207
J Clin Oncol. 2018 Apr 10;36(11):1080-1087
pubmed: 29384722
N Engl J Med. 2019 Jul 11;381(2):121-131
pubmed: 31157964
J Clin Oncol. 2021 Jul 10;39(20):2294-2303
pubmed: 33914595
Clin Cancer Res. 2019 Nov 15;25(22):6721-6730
pubmed: 31515456
J Clin Oncol. 2019 Feb 20;37(6):490-503
pubmed: 30625039
Dtsch Arztebl Int. 2021 Oct 22;118(42):713-719
pubmed: 34427180
Eur Heart J Cardiovasc Pharmacother. 2022 May 5;8(3):253-262
pubmed: 33470403
JAMA Oncol. 2020 May 1;6(5):650-659
pubmed: 32215577
Clin Genitourin Cancer. 2017 Aug 31;:
pubmed: 28899723
Eur Urol. 2020 Mar;77(3):365-372
pubmed: 31679970
Ann Oncol. 2018 May 1;29(5):1235-1248
pubmed: 29529169
Urologe A. 2020 Jun;59(6):673-679
pubmed: 32274540
Ann Oncol. 2019 Dec 1;30(12):1992-2003
pubmed: 31560068
Eur Urol. 2018 Jun;73(6):834-844
pubmed: 29037513
Eur Urol. 2019 Jul;76(1):115-124
pubmed: 30826218
Eur Urol. 2018 Aug;74(2):179-190
pubmed: 29678358
Lancet. 2018 Dec 1;392(10162):2353-2366
pubmed: 30355464
Eur Urol. 2019 Mar;75(3):410-418
pubmed: 30266309
Strahlenther Onkol. 2022 Aug;198(8):683-689
pubmed: 35704054
N Engl J Med. 2015 Aug 20;373(8):737-46
pubmed: 26244877